Early Gastric Cancer: Feasibility of CT Lymphography with Ethiodized Oil for Sentinel Node Mapping

Kim, Young Hoon; Lee, Yoon Jin; Park, Ji Hoon; Lee, Kyung Ho; Lee, Hye Seung; Park, Young Soo; Park, Do Joong; Kim, Hyung‐Ho

doi:10.1148/radiol.12121527

Cited by 17 publications

(32 citation statements)

References 47 publications

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“…CT lymphography is promising in that it can preoperatively depict SLNs (or the SLN basin) and provide detailed anatomic information (14,15,26,27). In our previous study, we performed CT lymphography with a water-soluble nonparticulate iodinated contrast agent (iopamidol) but experienced rapid tracer washout and consequently low SLN detection rate (15).…”

Section: Discussionmentioning

confidence: 99%

“…Such combinative strategies are Implication for Patient Care n Our lymphography method can be potentially integrated into current diagnostic and/or therapeutic workflow of early gastric cancer and therefore expand the application to gastric SLN assessment. recommended to compensate for the intrinsic limitations of individual tracers: Vital dyes transit and wash away rapidly and are difficult to detect in areas covered by dense fat tissue (9,11), whereas radioactive tracers demonstrate poor spatial resolution and poor sensitivity for detection of LNs near the injection site because of high background scattering (shine-through effect) (12)(13)(14). Moreover, these methods carry risks associated with radiation exposure in the operating room and require separate endoscopic sessions during surgery, which considerably increases the surgical operation time.…”

Section: Preparation and Characterization Of Fluorescent Iodized Oil mentioning

confidence: 99%

“…Recently, several groups, including ours, have reported promising results for preoperative computed tomographic (CT) imaging of SLNs using iopamidol (Isovue; Bracco Diagnostics, Princeton, NJ) (15)(16)(17), iodized oil emulsion (18), and ethiodized oil (14) in patients with gastric cancer or animal models. Preoperative CT lymphography for SLN mapping has the advantages of providing anatomic information about SLNs without intraoperative procedures and of reducing the surgical operation time.…”

Section: Advances In Knowledgementioning

confidence: 99%

“…Preoperative CT lymphography for SLN mapping has the advantages of providing anatomic information about SLNs without intraoperative procedures and of reducing the surgical operation time. However, during the surgical operation, additional procedures for identifying SLNs are still necessary (14,15,17,18).…”

Section: Advances In Knowledgementioning

confidence: 99%

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Fluorescent Iodized Emulsion for Pre- and Intraoperative Sentinel Lymph Node Imaging: Validation in a Preclinical Model

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Section: Discussionmentioning

confidence: 99%

Section: Preparation and Characterization Of Fluorescent Iodized Oil mentioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

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Fluorescent Iodized Emulsion for Pre- and Intraoperative Sentinel Lymph Node Imaging: Validation in a Preclinical Model

Kim¹,

Lee²,

Kim³

et al. 2015

Radiology

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“…In recent years, computed tomography lymphangiography, infrared ray electronic endoscopy, and indocyanine green fluorescence imaging are emerging as new tracers for laparoscopic SN biopsy [71,[80][81][82][83][84] .…”

Section: Laparoscopic Function-preserving Surgerymentioning

confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Jiang

Wang

et al. 2018

Journal of Surgical Oncology

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Background This meta‐analysis was conducted to evaluate the diagnostic value of near‐infrared (NIR) or fluorescent indocyanine green (ICG) guided sentinel lymph node (SLN) mapping in gastric cancer (GC). Methods This meta‐analysis was registered at the PROSPERO. Clinical studies were retrieved from the electronic database Pubmed, Embase, Medline, Web of science, and the Cochrane Library. Quality assessment was conducted by an adapted checklist of QUADAS‐2. A bivariate mixed‐effects model was used to pool the data. Evaluation of articles quality, analysis for publication bias, summary receiver operator characteristic (SROC) curves, and meta‐regression were also performed. Subgroup analysis was used to explain the heterogeneities. Results A total of 13 clinical studies (971 patients) were included. The NIR or fluorescent imaging (FI) involved infrared ray electronic endoscopy (IREE), infrared ray laparoscopic system (IRLS), and FI system. Significant evidence of heterogeneity was found for sensitivity and specificity (I 2 = 91.1% and I 2 = 98.2%), respectively. The pooled SLN sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.94(95%CI: 0.80‐0.99), 1.00(95%CI: 0.60‐1.00), 34.0(95%CI: 9.25‐125.29), 0.06(95%CI:0.02‐0.22), and 252.50(95%CI: 94.93‐671.61), respectively. Area under curve (AUC) of SROC curve was 1.00 (95%CI: 0.99‐1.00), and the summary operating point (cut‐off value) was SENS = 0.94(95%CI: 0.80‐0.99) and SPEC = 1.00(95%CI: 0.60‐1.00). Subgroup analysis showed that NIR imaging, imaging performed 20 minutes after intraoperative injection, preoperative injection (especially for FI imaging), stained with immunohistochemistry (IHC) (+hematoxylin‐eosin [HE]), cT1 stage, submucosa injection (especially for cT1), mean number of SLN ≥ 5, study size > 26 were associated with higher SLN sensitivity. In terms of ICG concentration, diluted ICG concentration that 0.5 mg/mL (compared with 5 mg/mL) in NIR imaging and 0.05 mg/mL (compared with 0.5 mg/mL) in FI system showed higher sensitivities. However, the differences in tumor diameter (≤30 mm vs >30 mm), gastrectomy methods (opening vs laparoscopy), lymphadenectomy methods (LBD vs pick‐up), and publication year (≥2010 vs <2010) did not achieve statistical significance. Conclusion ICG combined with NIR or FI guided SLN mapping is technically feasible for GC. Based on the small sample size evidence, the IREE and IRLS devices may have higher sensitivity than FI in current clinical studies; and there may be an excessive ICG concentration used for current SLN mapping in GC. However, well‐designed further studies with large sample size are needed to confirm the best procedure and suitable criteria. Mini‐abstract This meta‐analysis was registered at PROSPERO. Clinical studies on this topic were retrieved from the electronic database Pubmed, Embase, Medline, Web of Science, and the Cochrane Library. The NIR or FI involved IREE, IRLS, and FI techniques. A total of 13 clinical studies (9...

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Early Gastric Cancer: Feasibility of CT Lymphography with Ethiodized Oil for Sentinel Node Mapping

Abstract: CT lymphography with ethiodized oil may be a feasible method for sentinel node mapping in patients with early gastric cancer.

Cited by 17 publications

References 47 publications

Fluorescent Iodized Emulsion for Pre- and Intraoperative Sentinel Lymph Node Imaging: Validation in a Preclinical Model

Fluorescent Iodized Emulsion for Pre- and Intraoperative Sentinel Lymph Node Imaging: Validation in a Preclinical Model

Minimally Invasive Surgery of Gastric Cancer

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

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